Advancing health equity in prelicensure nursing curricula: Findings from a critical review

Nurses play a crucial role in reducing health disparities and advancing health equity for individuals and communities. The future nursing workforce relies on their nursing education to prepare them to promote health equity. Nursing educators prepare students through a variety of andragogical learning strategies in the classroom and in clinical experiences and by intentionally updating and revising curricular content to address knowledge and competency gaps. This critical review aimed to determine the extent to which health equity concepts are explicitly present in prelicensure undergraduate nursing curricula globally. Of 434 articles screened, 22 articles describing 20 studies met inclusion criteria. Frequency and quantity of health equity content, concepts and topics, teaching strategies, evaluation strategies, and the overall extent of integration varied widely. Notably, only two articles described overall well-integrated explicit health equity content, and there was little attention to whether students transfer this learning into practice. A focus on individualism rather than population and community was noted, highlighting the presence of whiteness in nursing. Results from this review confirm that nursing education has room to improve with respect to health equity in the curricula.

Effects of telehealth-assisted interventions among people living with HIV/AIDS: A systematic review and meta-analysis of randomized controlled studies

INTRODUCTION

Taking antiretroviral therapy (ART) is a daily necessity for people living with HIV but these individuals experience multiple barriers and challenges to medication adherence. Interventions to support medication adherence have yielded effects in the expected direction, but the extent to which telehealth or virtually delivered interventions to promote adherence are effective among people living with HIV/AIDS remains unknown. We aimed to address this knowledge gap and inform future research and practice that promotes the well-being of people living with HIV/AIDs through telehealth interventions addressing medication use.

METHODS

A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted using the following databases: Academic Search Complete, Cochrane library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE, PubMed, OVID (UpToDate), and the Web of Science. Relevant full-text articles published through September 2021 were retrieved. The revised Cochrane risk of bias tool for randomized trials was used to assess the methodological quality of the included studies. A meta-analysis was performed using a random-effects model to calculate the pooled effects of telehealth-assisted interventions for people living with HIV/AIDS. Stata 16.0 was used for statistical analysis.

RESULTS

A total of 12 studies (N = 3557 participants) that used telehealth-assisted interventions for people living with HIV/AIDS were included. Telehealth interventions were found to increase the adherence to treatment (standardized mean difference [SMD]: 0.21; 95% confidence interval (CI): 0.03 to 0.40), to reduce depressive symptoms (SMD: -2,74; 95% CI: -3.39 to -2.09), and to improve perceived quality of life (SMD: 0.74; 95% CI: 0.37 to 1.10).

DISCUSSION

The meta-effects of telehealth-assisted interventions include significantly enhanced adherence to treatment, improved quality of life, and reduced depressive symptoms among people living with HIV/AIDS. These findings suggesting that delivering health management interventions remotely through telehealth-assisted modalities was both feasible and effective in yielding health benefits for people living with HIV/AIDS. Integrating telehealth-assisted interventions as a modality in HIV/AIDS care might support continuity of care and sustained well-being. Future research should evaluate telehealth intervention outcomes and examine mediating, moderating, or other tailorable variables affecting intervention effectiveness.

Effects of telehealth interventions for adolescent sexual health: A systematic review and meta-analysis of randomized controlled studies

INTRODUCTION

Telehealth interventions to advance adolescent sexual health have evolved and are being used to promote adolescent sexual health knowledge and healthy sexual behaviors. However, as this area of intervention modality expands, there is a need to pause and examine the effects of telehealth interventions on adolescent sexual health outcomes. Addressing this knowledge gap will inform researchers and practitioners on the current state of evidence of telehealth interventions and inform further intervention development and testing. This study aimed to explore the meta-effects of telehealth interventions on self-efficacy of using condoms, condom use practices, and sexually transmitted infection testing behaviors among adolescents.

METHODS

A systematic review and meta-analysis of randomized controlled trials were conducted. Seven databases (Academic Search Complete, CINAHL, EMBASE, MEDLINE, PubMed, OVID (UpToDate), and Web of Science) were searched for relevant full-text articles from the inception to May 2021. The revised Cochrane risk-of-bias tool for randomized trials was used to assess the methodological quality of the included studies. A meta-analysis was performed using a random effects model to calculate the pooled effects of telehealth interventions for adolescents. Stata 16.0 was used for statistical analysis.

RESULTS

A total of 15 studies (N = 5499) that used telehealth interventions with adolescents were included in the analysis. Telehealth interventions were found to increase self-efficacy for condom use (standardized mean difference: 0.22; 95% confidence interval: 0.08-0.36), practice for condom use (standardized mean difference: 0.35; 95% confidence interval: 0.23-0.47), and being screened/tested for sexual transmitted infections (standardized mean difference: 0.61; 95% confidence interval: 0.31-0.92).

DISCUSSION

Telehealth interventions show promise as effective intervention delivery solutions for improving self-efficacy and certain sexual health behaviors among adolescents. These telehealth strategies could be important alternatives to in-person visits to accessing sexual health information or services near where they live. Future research should consider testing telehealth strategies where there is evidence of impact to move the field forward.

Sexual Violence in Virtual Reality: A Scoping Review

BACKGROUND

One in four Americans report experiencing harassment online via social media and interactive gaming, which includes physical threats, stalking, sexual harassment, and sustained harassment.

OBJECTIVE

The aim of this study was to gain understanding of the state of the science surrounding young adults and sexual violence/harassment harms in virtual reality (VR) as well as possible uses of VR to heal and intervene.

METHODS

A scoping review was conducted in early 2023 using the Ovid Synthesis Clinical Evidence Manager and the MEDLINE database. Forty-seven articles met inclusion criteria.

RESULTS

Our review found a growing body of evidence exploring incidents, effects, possible predictors, and initial strategies to prevent sexual violence in VR and to use the modality to positively intervene. Limited research addresses the effects of harms incurred in VR on (re)traumatization of survivors as well as the development and testing of VR tools used to educate, deliver bystander interventions, transform biases and perceptions via embodiment, and promote healing among survivors.

CONCLUSION

Research addressing sexual violence in VR is needed and should build on the existing peripheral science on gaming and social media environments. Forensic nursing is well positioned to advance strategies of health and safety in VR, just as in the physical world. Incorporating forensic nursing avatars in VR and deploying diverse resources targeted for college-age young adults to prevent harms in VR should be explored safely and ethically. Forensic nurses are also positioned to assess for VR-related harms among patients and to work with private and government sectors to influence regulations and policies.

Trade-Offs Faced by 2-and 4-Year College Students Experiencing Food Insecurity: An Analysis of Qualitative Data

PURPOSE

To understand the trade-offs, defined as compromises or decisions students must make to prioritize one important need over another, as a result of economic constraints, food insecure (FI) college students experience and the perceived impact of these challenges on health, well-being, and academic achievement.

DESIGN

8 Semi-structured focus groups.

SETTING

Seven 2- and 4-year Minnesota colleges.

PARTICIPANTS

53 students initially screening positive for FI.

METHOD

The focus groups were audio-recorded and transcribed verbatim. Thematic analysis, a systematic approach for identifying and analyzing patterns across qualitative data, was used through four analysis phases to identify themes and categories.

RESULTS

We identified five themes within trade-offs: sacrificing food, missing out on relationships, sacrificing academic studies, choosing between basic needs, and maintaining physical and mental well-being. The trade-offs students described were multifaceted, caused notable stress and worry, and presented challenges to students' well-being.

CONCLUSION

This study provides evidence on the complexities of FI among students and details on what students may be sacrificing as a result of making trade-offs. Understanding the trade-offs students are experiencing can help college staff to prioritize which issues to focus on to improve student health and academic performance.

A Trauma-Informed Mentoring Framework for Forensic Nurses: An Overview of STEERR-Structure, Process, and Evaluation

ABSTRACT

The STEERR Mentoring Framework, grounded in decolonized and feminist mentorship approaches, integrates foundational principles of mentoring with the unique and complex characteristics of the role of the forensic nurse. The primary objective of the program is to support a competent, sustainable, and resilient forensic nursing workforce. In this article, we describe the development process, framework structure, and evaluation approach implemented within a 1-year pilot initiative focused on forensic nurses in the sexual assault nurse examiner role. We reflect on strategies for broader application and replication in forensic nursing programs across the United States.

"It could bring down Greek life as a whole": Greek life members' perspectives on party culture, safety, responsibilities and consequences

OBJECTIVE

Describe Greek life students' perspectives of party culture, safety, and College Sexual Violence (CSV) prevention.

PARTICIPANTS

27 US undergraduates: 5 fraternity underclassmen, 6 fraternity upperclassmen, 10 sorority underclassmen, 6 sorority upperclassmen.

METHODS

Students participated in one of four focus groups, separately by gender and academic year. Facilitation guide addressed partying, sexual violence, and safety.

RESULTS

Greek life members described partying preferences, perceived safety threats, and actions they took to party safely. University efforts to support safe partying were not universally viewed as helpful.

CONCLUSIONS

Although Greek life students strive to create safe partying environments, there remain missed opportunities to mitigate risks related to CSV. The responsibility to ensure safe partying falls too heavily on students, resulting in universities missing opportunities to provide measures that promote safety while mitigating risks and potentially serious harms.

Weight Status Among Minnesota Hispanic or Latino/a Youth: An Exploration of Protective Factors

PURPOSE

Pediatric obesity disproportionately impacts Hispanic or Latino/a adolescents. Culturally appropriate family-based behavioral initiatives to improve weight status are warranted. The purpose of this research was to determine prevalence rates and identify protective factors associated with having overweight/obesity (body mass index ≥ 85^th percentile) to inform Hispanic or Latino/a-targeted behavioral intervention development.

DESIGN

Secondary data analyses of a population-based statewide survey.

SETTING

Minnesota public high schools.

PARTICIPANTS

Male (n = 2,644) and female (n = 2,798) Hispanic or Latino/a 9^th and 11^th graders (N = 5,442).

MEASURES

Obesity-related behaviors (meeting fruit and vegetable [F&V] and physical activity [PA] recommendations), family caring, family country/region of origin, and weight status.

ANALYSIS

Stepwise logistic regression models (F&V, PA), stratified by biological sex, were used to identify protective factors of overweight/obesity.

RESULTS

The overall prevalence of meeting F&V and PA recommendations was 11.0% and 11.8%, respectively. Meeting F&V recommendations was not protective against overweight/obesity in either sex. Yet, males and females who met PA recommendations had significantly lower odds of having overweight/obesity (p < .05). In F&V and PA models, family caring was protective against overweight/obesity in females (p < .05), and family country/region of origin was protective against overweight/obesity in both sexes (p < .05).

CONCLUSION

Findings illustrate a need for obesity prevention initiatives for Hispanic or Latino/a youth. More research is needed to understand the protective nature of family caring and country/region of origin.

Effects of telehealth intervention for people with dementia and their carers: A systematic review and meta-analysis of randomized controlled studies

PURPOSE

Interventions delivered using telehealth modalities are becoming standard practice with patient populations around the world, partly because of innovation necessitated by the COVID-19 pandemic and partly due to improved infrastructure and comfort of providers, patients, and families, through technology. Though increasingly utilized, the effectiveness of telehealth interventions with families with dementia remains unclear. This gives rise to the need for investigation to develop telehealth interventions that are evidence based and not merely convenient tools. This current study is designed to systematically examine the impact and effectiveness of telehealth-delivered psychoeducational and behavioral interventions among persons with dementia and their caregivers.

DESIGN

The design combines systematic review and meta-analysis.

METHODS

A total of eight databases were electronically accessed and searched as of November 16, 2021. Experimental studies identifying the results of telehealth interventions for persons with dementia and associated caregivers published in English have been reviewed in this study. Standardized mean differences (SMD) offering 95% confidence intervals (CI) were developed to pool the effect size using a random effects model (in this case, Stata 16.0). The Revised Cochrane Risk-of-Bias Tool for Randomized Trials (RoB-2) was used to analyze the study's methodological soundness.

FINDINGS

Nineteen cases met the eligibility criteria (including 1379 persons with dementia and 1339 caregivers). Overall, telehealth interventions demonstrated effects in the expected directions on depression (SMD -0.63; 95% degree of confidence intervals (CI) -0.88 to -0.38, p < 0.001); and caregivers' perceived competency (SMD 0.27; 95% CI -0.05 to 0.50, p = 0.02). There were, however, no statistically significant effects observed on cognitive function or multiple aspects of quality of life for subjects.

CONCLUSIONS

Telehealth interventions appear to effect a reduction in depression among persons diagnosed with dementia while improving the perceived competency of caregivers.

CLINICAL RELEVANCE

The study's results could be used as evidence of the effectiveness of using telehealth for persons with dementia and their caregivers, including contextualizing where they are used (i.e., long-term care facilities, private homes, etc.), understanding the mechanisms in play (including intervention delivery and systems), and isolating and identifying mediating influences.

Effects of telehealth-assisted interventions for secondary prevention of cardiovascular disease: A systematic review and meta-analysis

BACKGROUND

Telehealth-assisted interventions have been used as secondary prevention measures in cardiac rehabilitation, especially for the delivery of information between healthcare service providers and patients. However, as the application of this intervention modality broadens, investigation of its effects in secondary prevention of cardiovascular disease (CVD) is necessary.

AIMS

To identify the effectiveness of telehealth-assisted interventions for secondary prevention of CVD.

DESIGN

Systematic review and meta-analysis.

METHODS

The PRISMA protocol was used to conduct a systematic review and meta-analysis of randomised controlled trials. The full text of articles was obtained from six databases for the period from database establishment to 25 November 2021. To assess the methodological quality of the studies reviewed, the updated Cochrane risk-of-bias checklist for randomised trials was employed. A meta-analysis was performed using a random-effects model to calculate the pooled effects of telehealth-assisted interventions for secondary CVD prevention.

RESULTS

The final analysis included 4012 individuals from 18 different trials. Telehealth-assisted interventions were shown to improve medication adherence (standardised mean difference [SMD]: 0.31; 95% confidence interval [CI]: 0.33-0.59) and reduce depression (SMD: -0.28; 95% CI: -0.46 to -0.10).

CONCLUSIONS

Telehealth-assisted interventions appear to improve adherence to medication and reduce depression of individuals with CVD. These intervention strategies could be offered to both healthcare providers and individuals with CVD as an option in delivering and facilitating the use of health services to improve health behaviours and overall outcomes. Furthermore, this study may be used as guidance for future research to provide an appropriate plan of care for this population.

RELEVANCE TO CLINICAL PRACTICE

The findings imply that the delivery of care remotely via telehealth-assisted interventions for secondary prevention of CVD is beneficial in improving CVD survivors' health and access to healthcare services.

TRIAL REGISTRATION

The International Prospective Register of Systematic Review: (PROSPERO): CRD 42021290111.

Sex in the Context of Substance Use: A Study of Perceived Benefits and Risks, Boundaries, and Behaviors among Adolescents Participating in an Internet-Based Intervention

Little research has examined adolescents' perspectives of sex with substance use. This study examined (1) adolescents' perceived benefits and risks of sex with substance use, as well as boundaries; (2) the potential for positive and negative social influences among adolescents when they discuss these topics; and (3) whether exposure to health-promoting content is associated with trajectories of sex with substance use over a 6-month period. To address the first two objectives, 176 comments were analyzed from 71 adolescents (90% female) aged 14-18 years who participated in an Internet-based sexual health promotion intervention and posted to at least one message board addressing sex with substance use. Adolescents' perceived benefits and risks of sex with substance use primarily reflected concern for the experience of sex in the moment; perceived risks and boundaries primarily reflected concern for the ability to develop and maintain meaningful relationships. Comments of 63% and 22% of adolescents, respectively, were evaluated to have potential for health-promoting and risk-promoting social influence. To address the third objective, trajectories of self-reported sex with substance use were compared between 89 intervention and 54 control participants. No significant differences were observed. However, a dose-response effect was observed; intervention participants who completed less than one third of assigned tasks reported increases in sex with alcohol or marijuana use over time, while no marked changes or much smaller changes in sex with substance use were observed among intervention participants who completed one third or more tasks. Implications for prevention and intervention programs are discussed.

Barriers to and Facilitators for Acceptance of Comprehensive Clinical Decision Support System-Driven Care Maps for Patients With Thoracic Trauma: Interview Study Among Health Care Providers and Nurses

BACKGROUND

Comprehensive clinical decision support (CDS) care maps can improve the delivery of care and clinical outcomes. However, they are frequently plagued by usability problems and poor user acceptance.

OBJECTIVE

This study aims to characterize factors influencing successful design and use of comprehensive CDS care maps and identify themes associated with end-user acceptance of a thoracic trauma CDS care map earlier in the process than has traditionally been done. This was a planned adaptive redesign stage of a User Acceptance and System Adaptation Design development and implementation strategy for a CDS care map. This stage was based on a previously developed prototype CDS care map guided by the Unified Theory of Acceptance and Use of Technology.

METHODS

A total of 22 multidisciplinary end users (physicians, advanced practice providers, and nurses) were identified and recruited using snowball sampling. Qualitative interviews were conducted, audio-recorded, and transcribed verbatim. Generation of prespecified codes and the interview guide was informed by the Unified Theory of Acceptance and Use of Technology constructs and investigative team experience. Interviews were blinded and double-coded. Thematic analysis of interview scripts was conducted and yielded descriptive themes about factors influencing the construction and potential use of an acceptable CDS care map.

RESULTS

A total of eight dominant themes were identified: alert fatigue (theme 1), automation (theme 2), redundancy (theme 3), minimalistic design (theme 4), evidence based (theme 5), prevent errors (theme 6), comprehensive across the spectrum of disease (theme 7), and malleability (theme 8). Themes 1 to 4 addressed factors directly affecting end users, and themes 5 to 8 addressed factors affecting patient outcomes. More experienced providers prioritized a system that is easy to use. Nurses prioritized a system that incorporated evidence into decision support. Clinicians across specialties, roles, and ages agreed that the amount of extra work generated should be minimal and that the system should help them administer optimal care efficiently.

CONCLUSIONS

End user feedback reinforces attention toward factors that improve the acceptance and use of a CDS care map for patients with thoracic trauma. Common themes focused on system complexity, the ability of the system to fit different populations and settings, and optimal care provision. Identifying these factors early in the development and implementation process may facilitate user-centered design and improve adoption.

Mental health of US undergraduate and graduate students before and during the COVID-19 pandemic: Differences across sociodemographic groups

The purposes of this study were to assess differences between sociodemographic groups in student mental health before and during the COVID-19 pandemic, to investigate whether the pandemic disproportionately affected certain groups, and to examine between-group differences in pandemic-related stressors. Data from Minnesota undergraduate and graduate students who completed an online survey in 2020 (N = 2,067) were compared to data collected from students in 2018 (N = 3,627). The survey assessed days of poor mental health, stress, stress management ability, days of adequate sleep, and pandemic-related stressors (2020 only). Multivariate analyses of variance assessed differences between study years (2020 vs. 2018), sociodemographic groups (gender, sexual orientation, race, disability, international student), and their interactions with study year in predicting mental health, and the sociodemographic groups in predicting pandemic stressors, among undergraduate and graduate students. Stress management ability decreased and sleep improved from 2018 to 2020. The sociodemographic variables most associated with poorer mental health were identifying as female, a sexual minority, or having a disability. Undergraduates reported poorer mental health than graduate students. Differences between sociodemographic groups were not larger during the pandemic, except among students with disabilities. All five sociodemographic variables were related to greater pandemic stressors in some domains.

Communication about Sexual Consent and Refusal: A Learning Tool and Qualitative Study of Adolescents' Comments on a Sexual Health Website

Sexual communication skills are needed to create healthy romantic relationships. Arguably, these skills also can be used to prevent some instances of unwanted sex. This study presents a qualitative analysis of adolescents' comments after reading a teen-friendly article on sexual consent as part of a web-based sexual health promotion intervention. The sample was comprised predominantly of female adolescents recruited from a Midwest urban region in the United States. Adolescents varied with respect to self-efficacy to request, provide, and deny consent, as well as the perceived need to ask for consent in the context of established relationships. Many adolescents perceived that nonverbal methods of communication were sufficient to request, provide, or deny sexual consent. Factors that make it difficult to discuss sexual boundaries and say "no" to unwanted sex included low self-efficacy and an underlying desire to nurture or preserve a relationship. Cultural norms must be changed to support verbal, affirmative sexual consent. In addition, adolescents must be aided in the development of skills to request sexual consent, say "yes" to specific activities, and say "no" to others. Without supportive norms and skills to enhance self-efficacy, adolescents may be unwilling to engage in verbal communication about sexual consent and boundaries.

Pathways to Breast Cancer Diagnosis and Treatment Among Women in Ghana: A Qualitative Study

Background: Breast cancer is the leading cause of cancer death among Ghanaian women and most women are identified once they develop symptoms. Women then must navigate a complex health care system to get diagnosed and receive orthodox medicine. We describe Ghanaian women's pathways of care from breast cancer-related symptom detection to treatment receipt.

Methods: We conducted a qualitative study using an empirical phenomenological approach. We used a purposive sampling technique to recruit 31 women with breast cancer who were receiving treatment at Komfo Anokye Teaching Hospital in Kumasi, Ghana. They participated in semistructured in-depth interviews between November 2019 and March 2020. All interviews were transcribed verbatim and analyzed using a deductive coding approach.

Results: Women navigate approximately nine steps from symptom detection to receiving orthodox breast cancer treatment. The breast cancer care pathway is not linear and women frequently move among different management approaches, including alternative therapy (faith healing and traditional herbal healing). All the women detected the symptoms themselves. Some of the women sought orthodox medicine due to information from the media.

Conclusions: Alternative therapy providers play a critical role in the breast cancer diagnosis and care pathways in Ghana underscoring the need to formally integrate them into the health care system. Breast cancer awareness programs through the media and educational programs aimed at alternative therapy providers may reduce the time from symptom detection to receipt of orthodox medicine.

First- and Second-Hand Experiences of Enacted Stigma Among LGBTQ Youth

Research on enacted stigma, or stigma- and bias-based victimization, including bullying and harassment, among lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth often focuses on one context (e.g., school) or one form (e.g., bullying or microaggressions), which limits our understanding of these experiences. We conducted qualitative go-along interviews with 66 LGBTQ adolescents (14-19 years) in urban, suburban, town, and rural locations in the United States and Canada identified through purposive and snowball sampling. Forty-six participants (70%) described at least one instance of enacted stigma. Three primary themes emerged: (1) enacted stigma occurred in many contexts; (2) enacted stigma restricted movement; and (3) second-hand accounts of enacted stigma shaped perceptions of safety. Efforts to improve well-being among LGBTQ youth must address the diverse forms and contexts of enacted stigma that youth experience, which limit freedom of movement and potential access to opportunities that encourage positive youth development. School nurses can play a critical role in reducing enacted stigma in schools and in collaboration with community partners.

Sexual Assault, Sexual Orientation, and Reporting Among College Students

Research has demonstrated significantly higher rates of sexual assault victimization among lesbian, gay, bisexual and queer (LGBQ) students than heterosexual students, and the overwhelming majority of assaults are not reported to any official system. Given the potential for support services to provide valuable assistance and promote well-being after an assault, the present study explores whether LGBQ students report assaults at similar rates to heterosexual students. As part of the 2015 College Student Health Survey, 10,646 male and female college students at 2- and 4-year colleges in Minnesota provided data regarding sexual assault victimization; reporting to a health care provider, campus authority, police, or social contact; and sexual orientation (two items, including write-in). Chi-square tests were used to detect associations between sexual assault victimization and five sexual orientation groups; and between sexual orientation and assault reporting (for 523 assault incidents). Almost 6% of students reported that they had experienced sexual assault in the previous 12 months. Significant differences in assault experience were seen by sexual orientation groups, for both males and females. For example, rates of sexual assault were 2.5 to over 5 times higher among bisexual and queer/pansexual/other females than among heterosexual females. Reporting of sexual assault to health care providers, campus authorities or police was rare for both heterosexual and sexual minority students, and there were no significant differences in reporting across sexual orientation. LGBQ students and heterosexual students appear to be similarly comfortable accessing health care providers, police, and campus resources, suggesting that these services are not overtly biased or unwelcoming to sexual minorities. However, rates of sexual assault were considerably higher among sexual minority groups, suggesting a need for primary prevention that is appropriate and sensitive to the experiences of LGBQ students.

Family Relationships and the Health and Well-Being of Transgender and Gender-Diverse Youth: A Critical Review

Transgender and gender-diverse (TGD) youth experience significant health and well-being disparities compared to their cisgender peers. However, disparities experienced at a population level might be mitigated by individual-level factors such as strong family relationships. Discrete aspects of strong family relationships may impact the health and well-being of TGD youth differently. To date, no systematic review known to us has explored the state of the science regarding the association between family relationships and the health and well-being of TGD adolescents and young adults. As such, our review aimed to (1) compile and present the scientific literature addressing the connection between family relationships and the health and well-being of TGD youth in those families; (2) sort results utilizing the Family Strengths Model; and (3) assess the strength of the literature with evidence-based appraisal tools. Sixteen articles met eligibility criteria (10 quantitative and 6 qualitative). These articles discussed family relationship qualities influencing health and well-being outcomes, including mental health, homelessness, sexual health, and substance use. Three of six qualities of strong families-coping ability, appreciation and affection, and positive communication-were represented in the literature. The risk for bias and study strength appraisals suggest that the available literature is moderately strong overall. Certain characteristics of strong families (commitment, enjoyable time spent together, and spiritual well-being) were underrepresented in the literature. Future research should explore these gaps to ensure that health care and community service providers can deliver the most effective support and care for TGD youth and their families.

Evaluating the Feasibility and Acceptability of a Community-Based Parenting Support Intervention for Refugee Parents From Burma

Refugee families negotiate stressors as they adjust to communities of resettlement, which can result in shifting family dynamics. The purpose of this community-engaged, explanatory, mixed-methods pilot study was to evaluate the feasibility and acceptability of a culturally oriented, community-based parenting curriculum. Through a partnership with a prominent refugee-serving organization, the curriculum was delivered to 50 Karen refugee mothers and fathers of adolescent youth resettled in the United States. Results demonstrated the potential for impact on key constructs of family adaptability and cohesion, as well as parent self-efficacy. Participants were highly engaged with the program and attrition was low.

"It makes such a difference": An examination of how LGBTQ youth talk about personal gender pronouns

BACKGROUND AND PURPOSE

The World Health Organization has developed standards for youth-friendly health services to support adolescents and encourage health care utilization among youth. Necessary building blocks for youth-friendly care include strong interpersonal relationships between youth and health care providers. Nurse practitioners (NPs) may be particularly well positioned to form these relationships. This study explored a core aspect for building youth-provider relationships. The study examined how lesbian, gay, bisexual, transgender, and queer (LGBTQ) adolescents discussed use of personal pronouns (e.g., he, she, they, ze) in relation to transgender and gender diverse (TGD) people.

METHODS

A secondary qualitative analysis of 66 in-depth interviews with LGBTQ youth from across Minnesota, Massachusetts, and British Columbia, Canada was conducted. Results were sorted into four main themes describing different aspects of personal pronoun use as related to TGD individuals.

CONCLUSIONS

Stories and experiences shared by participants illustrate how to assess which pronouns to use for a given person, how to use pronouns in different contexts, why respecting pronouns is important to TGD people, and flexibility as an integral component of the learning process when it comes to appropriate pronoun use.

IMPLICATIONS FOR PRACTICE

Understanding how youth discuss personal pronouns could improve practice with TGD youth. Each of the four themes can be applied to clinical encounters to ensure culturally sensitive care. Practice recommendations include asking adolescents what pronouns they prefer clinic staff to use on intake forms and having NPs and clinic staff provide their own pronouns to patients in introductions.

Relationships Between Adolescent Stress, Depressive Symptoms, and Sexual Risk Behavior in Young Adulthood: A Structural Equation Modeling Analysis

INTRODUCTION

This study examined longitudinal associations between stressful life events and depressive symptoms, assessed during two time points of adolescence, and sexual risk behavior, assessed during young adulthood.

METHODS

Structural equation modeling was conducted with three waves of data from the National Longitudinal Study of Adolescent to Adult Health.

RESULTS

Analyses revealed bidirectional relationships between stressful life events and depressive symptoms during the two time points of adolescence. Adolescent depressive symptoms indirectly affected young adult sexual risk behavior through adolescent stressful life events. Adolescent stressful life events during late adolescence were directly associated with young adult sexual risk behavior.

DISCUSSION

Findings highlight the need to screen for both depression and stressful life events during adolescence, to identify at-risk adolescents and deliver tailored interventions to prevent sexual risk behavior during young adulthood.

Perceptions of Sexual Orientation and Gender Identity Minority Adolescents About Labels

Young peoples' acceptance and use of nontraditional, descriptive identity labels (e.g., pansexual, genderqueer) require nurses to consider moving beyond use of traditional terms (e.g., gay, transgender). This mixed methods study explores (a) labels used by sexual orientation and gender identity (SOGI) minority youth, (b) their expressed importance and meaning of these labels, and (c) differences in label usage. Sixty-six SOGI minority adolescents in British Columbia, Minnesota, and Massachusetts (mean age = 16.6) participated in "go-along" interviews; during interviews, 42 (63.6%) commented on labels. Chi-square and t tests were used to compare traditional versus nontraditional labels across participant demographic categories. Inductive thematic analysis was used to identify representative themes. Approximately, 1/3 of participants used nontraditional sexual orientation identity labels; this finding was associated with a trans identity and nontraditional gender labels. Using terminology that is meaningful and representative to the youth themselves has potential to facilitate representative research and welcoming environments in practice.

Sexual Assault Reporting and Emotional Distress Among College Female-Identified Victims/Survivors

PURPOSE

The current study tests associations between reporting sexual victimization to a healthcare provider, campus authority, police, or social contact, and emotional well-being among college women.

METHODS

Data from 2,162 women who participated in the 2015 College Student Health Survey at 17 colleges in Minnesota was used. Analyses tested associations between reporting sexual assault to formal or informal resources and diagnosis with anxiety, depression, panic attacks, and posttraumatic stress disorder, as well as self-rated health.

RESULTS

Significantly higher rates of all four diagnoses were observed among those who reported to formal resources (e.g., healthcare provider, police) compared with those who reported to informal resources (i.e., friends, family). However, no differences were seen in self-rated physical or mental health.

CONCLUSIONS

Expansion of trauma-informed healthcare services and advocacy efforts is recommended to optimally support students who report sexual assault experiences.

Smoking behaviours among heterosexual and sexual minority youth? Findings from 15 years of provincially representative data

INTRODUCTION AND AIMS

Sexual identity disparities in smoking behaviours are well established; however, there is limited research on whether these disparities have diminished as the social and political landscape has changed for lesbian, gay and bisexual people. Thus, we examined changes in prevalence and sexual identity disparities in three smoking behaviours among Canadian adolescents from 1998 to 2013.

DESIGN AND METHODS

Data are from the provincially representative British Columbia Adolescent Health Survey (N = 99 373). Using sex-stratified, age-adjusted logistic regression models, we estimated: (i) trends in lifetime cigarette use, early onset, and past 30-day use for heterosexual and three subgroups of sexual minority (i.e. mostly heterosexual, bisexual and gay/lesbian) youth; (ii) sexual identity disparities in these cigarette-related behaviours within each survey year (1998, 2003, 2008, 2013); and (iii) whether the size of the disparity has changed from 1998 to 2013.

RESULTS

Smoking has declined for all youth from 1998 to 2013, although less consistently for sexual minority youth. Within-year disparity estimates indicated elevated prevalence of cigarette use for sexual minority compared to heterosexual youth, particularly among females. Trends in sexual identity and smoking behaviours indicated that the degree of differences between heterosexual and sexual minority youth have remained stable or, in some cases, widened. Heterosexual and sexual minority youth differences widened for early onset among sexual minority boys and lifetime and past 30-day use for sexual minority girls.

DISCUSSION AND CONCLUSIONS

Efforts to prevent smoking behaviours among youth should continue. Tailored preventive strategies for sexual minority youth might help address existing disparities.

Unhealthy weight control behaviors among youth: Sex of sexual partner is linked to important differences

Unhealthy weight control behaviors (UWCBs) have been decreasing for most youth over time, yet little is known whether these behaviors have changed for sexual minority (e.g., non-heterosexual) youth. This is important because many studies have found that sexual minorities report some of the highest rates of UWCBs. To determine whether or not these behaviors have changed over time, given the extreme changes in social contexts over the past two decades, we utilised three waves of the Minnesota Student Survey (N = 55,597, M_age = 17). In doing so, we report trends, disparities, and changes in disparities of UWCBs. Overall, the prevalence of UWCBs has declined from 1999 to 2010 for all youth, but there are alarming disparities by sex of sexual partner. We found that both- and same-sex partnered male youth were more likely to fast, use diet pills, and vomit on purpose to lose weight compared to their opposite-sex partnered counterparts in all three survey years; specifically, both-sex partnered boys were up to 5.5× as likely to vomit on purpose compared to their opposite-sex partnered counterparts. Likewise, both-sex partnered girls were more likely to use diet pills and vomit on purpose to lose weight compared to opposite-sex partnered girls in all three survey years. Additionally, the disparity in fasting to lose weight widened for the same-sex partnered females compared to the opposite-sex partnered females from 1998 to 2004. This has implications for UWCB interventions and preventions targeted specifically towards sexual minorities.

Trend Disparities in Emotional Distress and Suicidality Among Sexual Minority and Heterosexual Minnesota Adolescents From 1998 to 2010

BACKGROUND

Sexual minority young people have demonstrated higher rates of emotional distress and suicidality in comparison to heterosexual peers. Research to date has not examined trends in these disparities, specifically, whether there have been disparity reductions or increases and how outcomes have differed over time by sex and sexual orientation group.

METHODS

Minnesota Student Survey data, collected from 9th and 12th graders in 3 cohorts (1998, 2004, 2010) were used to examine emotional distress and suicidality rates. Logistic regression analyses were completed to examine outcome changes over time within and across sexual orientation/sex groups.

RESULTS

With few exceptions, sexual minority youth are at increased risk of endorsing emotional distress and suicidality indicators in each surveyed year between 1998 and 2010. Young people with both-sex partners reported more emotional distress across all health indicators compared to their opposite-sex partnered peers. With a few exceptions, gaps in disparities between heterosexual and sexual minority have not changed from 2004 to 2010.

CONCLUSIONS

Disparities in emotional health persist among youth. Research is needed to advance understanding of mental health disparities, with consideration of sexual orientation differences and contextualized to sociocultural status and changes over time. Personalized prevention strategies are needed to promote adolescent mental health.

COME ALONG WITH ME: LINKING LGBTQ YOUTH TO SUPPORTIVE RESOURCES

In this study, we examine how lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth, who tend to experience greater feelings of isolation and discrimination than heterosexual youth, find and become integrated into supportive activities and resources. As part of a larger study on supportive lesbian, gay, bisexual, transgender, and queer youth environments, 66 go-along interviews with LGBTQ youth, from Massachusetts, Minnesota, and British Columbia were conducted. Analysis of these interviews identified important cues that prompt self-agency and integration into supportive environments and affirmative identities. In particular, we argue indirect links or cues such as media and print advertisements increase awareness of supports and resources, while personal links, such as referrals from trusted friends, adults, and regularly attended programs, can help youth form denser networks of support.

Bi-national cross-validation of an evidence-based conduct problem prevention model

OBJECTIVES

To (a) explore the preferences of Mexican parents and Spanish-speaking professionals working with migrant Latino families in Minnesota regarding the Mexican-adapted brief model versus the original conduct problems intervention and (b) identifying the potential challenges, and preferred solutions, to implementation of a conduct problems preventive intervention.

METHOD

The core practice elements of a conduct problems prevention program originating in the United States were adapted for prevention efforts in Mexico. Three focus groups were conducted in the United States, with Latino parents (n = 24; 2 focus groups) and professionals serving Latino families (n = 9; 1 focus group), to compare and discuss the Mexican-adapted model and the original conduct problems prevention program. Thematic analysis was conducted on the verbatim focus group transcripts in the original language spoken.

RESULTS

Participants preferred the Mexican-adapted model. The following key areas were identified for cultural adaptation when delivering a conduct problems prevention program with Latino families: recruitment/enrollment strategies, program delivery format, and program content (i.e., child skills training, parent skills training, child-parent activities, and child-parent support). For both models, strengths, concerns, barriers, and strategies for overcoming concerns and barriers were identified.

CONCLUSIONS

We summarize recommendations offered by participants to strengthen the effective implementation of a conduct problems prevention model with Latino families in the United States. This project demonstrates the strength in binational collaboration to critically examine cultural adaptations of evidence-based prevention programs that could be useful to diverse communities, families, and youth in other settings. (PsycINFO Database Record

"It's Like a Cyber-Security Blanket": The Utility of Remote Activity Monitoring in Family Dementia Care

Technologies have emerged that aim to help older persons with Alzheimer's disease and related dementias (ADRDs) remain at home while also supporting their caregiving family members. However, the usefulness of these innovations, particularly in home-based care contexts, remains underexplored. The current study evaluated the acceptability and utility of an in-home remote activity monitoring (RAM) system for 30 family caregivers of persons with ADRD via quantitative survey data collected over a 6-month period and qualitative survey and interview data collected for up to 18 months. A parallel convergent mixed methods design was employed. The integrated qualitative and quantitative data suggested that RAM technology offered ongoing monitoring and provided caregivers with a sense of security. Considerable customization was needed so that RAM was most appropriate for persons with ADRD. The findings have important clinical implications when considering how RAM can supplement, or potentially substitute for, ADRD family care.

Male Help-Seeking After Sexual Assault: A Series of Case Studies Informing Sexual Assault Nurse Examiner Practice

BACKGROUND

A series of three composite case studies of cisgender men who presented to an emergency department for care after experiencing a sexual assault are presented. These cases show common assault characteristics including substance use, force, and multiple perpetrators.

METHODS

We describe the sexual assault nurse examiner (SANE) findings and treatment and provide legal details of specific cases when available.

RESULTS

These case reports highlight common challenges to help-seeking and the primary reasons these male victims overcame the barriers to seek care.

DISCUSSION

SANEs are encouraged to provide consistent care to all sexual assault patients, regardless of gender. SANEs have an obligation to educate peers and broader society about sexual assault prevention and to advocate for policies that encourage help-seeking when a sexual assault has occurred.

Are alcohol-related disparities between sexual minority and heterosexual youth decreasing?

BACKGROUND AND AIMS

Although sexual orientation-related alcohol use disparities are well established, researchers have not identified whether disparities are diminishing as societal attitudes towards lesbian/gay and bisexual (LGB) people become more accepting. We examined changes in four alcohol-related disparities between heterosexual and LGB youth from 1998 to 2013 by (1) estimating the prevalence of these behaviors; (2) estimating disparities in alcohol-related outcomes between heterosexual and LGB youth within each wave year; and (3) testing whether the degree of difference in alcohol-related disparities between heterosexual and LGB youth has changed.

DESIGN

Logistic regression models and year × sexual orientation interactions with repeated, cross-sectional, provincially representative data.

SETTING

British Columbia, Canada.

PARTICIPANTS

Students (ages 12-19) from the 1998 (n = 22 858), 2003 (n = 29 323), 2008 (n = 25 254) and 2013 (n = 21 938) British Columbia Adolescent Health Survey (total n = 99 373, 48.7% male, mean age = 14.84).

MEASUREMENTS

We modeled age-adjusted differences in life-time alcohol use, age of onset, past 30-day drinking and past 30-day heavy episodic drinking between heterosexual and three subgroups of sexual minority youth (i.e. mostly heterosexual, bisexual and lesbian/gay).

FINDINGS

Generally, alcohol use declined for all youth, although less so among LGB youth [average adjusted odds ratio (aOR) = 0.58 and aOR = 0.53 for heterosexual males and females and aOR = 0.71 and aOR = 0.57 for sexual minority males and females, respectively). Within-year comparisons demonstrated elevated rates of alcohol use among LGB compared with heterosexual youth for each of the four survey years, especially among females. Findings indicate few changes over time; however, results show an increase in risky alcohol use from 1998 to 2013 among mostly heterosexual (aOR = 1.58 for life-time alcohol use, aOR = 1.58 for 30-day alcohol use and aOR = 1.34 for 30-day heavy episodic drinking), and bisexual (aOR = 1.95 for life-time alcohol use) females.

CONCLUSION

Despite the general decline in the prevalence of alcohol use among young people in Canada since 1998, lesbian/gay and bisexual youth in Canada continue to show elevated rates of alcohol use compared with heterosexual youth.

Helping Young People Stay Afloat: A Qualitative Study of Community Resources and Supports for LGBTQ Adolescents in the United States and Canada

LGBTQ youth are at increased risk of poor health outcomes. This qualitative study gathered data from LGBTQ adolescents regarding their communities and describes the resources they draw on for support. We conducted 66 go-along interviews with diverse LGBTQ adolescents (mean age = 16.6) in Minnesota, Massachusetts, and British Columbia in 2014-2015, in which interviewers accompanied participants in their communities to better understand those contexts. Their responses were systematically organized and coded for common themes, reflecting levels of the social ecological model. Participants described resources at each level, emphasizing organizational, community, and social factors such as LGBTQ youth organizations and events, media presence, and visibility of LGBTQ adults. Numerous resources were identified, and representative themes were highly consistent across locations, genders, orientations, racial/ethnic groups, and city size. Findings suggest new avenues for research with LGBTQ youth and many opportunities for communities to create and expand resources and supports for this population.

LGBTQ Youth's Views on Gay-Straight Alliances: Building Community, Providing Gateways, and Representing Safety and Support

BACKGROUND

Gay-Straight Alliances (GSAs) are school-based clubs that can contribute to a healthy school climate for lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth. While positive associations between health behaviors and GSAs have been documented, less is known about how youth perceive GSAs.

METHODS

A total of 58 LGBTQ youth (14-19 years old) mentioned GSAs during go-along interviews in 3 states/provinces in North America. These 446 comments about GSAs were thematically coded and organized using Atlas.ti software by a multidisciplinary research team.

RESULTS

A total of 3 themes describe youth-perceived attributes of GSAs. First, youth identified GSAs as an opportunity to be members of a community, evidenced by their sense of emotional connection, support and belonging, opportunities for leadership, and fulfillment of needs. Second, GSAs served as a gateway to resources outside of the GSA, such as supportive adults and informal social locations. Third, GSAs represented safety.

CONCLUSIONS

GSAs positively influence the physical, social, emotional, and academic well-being of LGBTQ young people and their allies. School administrators and staff are positioned to advocate for comprehensive GSAs. Study findings offer insights about the mechanisms by which GSAs benefit youth health and well-being.

Living as an LGBTQ Adolescent and a Parent's Child: Overlapping or Separate Experiences

It is well known that parental and community-based support are each related to healthy development in lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth, but little research has explored the ways these contexts interact and overlap. Through go-along interviews (a method in which participants guide the interviewer around the community) with 66 youth in British Columbia, Massachusetts, and Minnesota, adolescents (aged 14-19 years) reported varying extent of overlap between their LGBTQ experiences and their parent-youth experiences; parents and youth each contributed to the extent of overlap. Youth who reported high overlap reported little need for resources outside their families but found resources easy to access if wanted. Youth who reported little overlap found it difficult to access resources. Findings suggest that in both research and practice, considering the extent to which youth feel they can express their authentic identity in multiple contexts may be more useful than simply evaluating parental acceptance or access to resources.

Go-along interviewing with LGBTQ youth in Canada and the United States

Go-along interviews, which are interviews conducted whilst being in and moving within participant selected spaces, were conducted with 66 LGBTQ adolescents (14-19 years old) in their self-identified communities to explore perceived community attributes, including safe spaces, resources, and supports; this paper highlights methodological lessons learned. Successful recruitment in two countries and varied community settings required partnership with local LGBTQ supporting agencies, including school-based Gay Straight Alliances. Youth chose to walk, use public transportation, and drive to community locations, identifying numerous formal and informal resources in their communities. Participant reflections highlighted that go-along interviews can be conducted in safe ways that encourage LGBTQ youth to express themselves about communities in which they live, study, work, play, and relax.

Sexual Violence Among College Students: An Examination of Individual and Institutional Level Factors Associated With Perpetration

BACKGROUND

Sexual violence incidents involving college students have received media attention and increased awareness of this public health problem in the United States; prevention efforts are needed that target potential perpetrators. We examined characteristics of self-reported perpetrators of sexual violence on campuses.

METHODS

This study used a secondary data analysis of the 2015 College Student Health Survey, an annual survey, which was completed by students attending 17 colleges/universities in Minnesota. The analytic sample included 6,548 18-to 24-year-old college students who answered at least one of two questions assessing perpetration in the past 12 months (i.e., sex/sexual touch without consent). Chi-square tests were used to detect associations between perpetration and individual (e.g., age, race, substance use, victimization) and institutional (e.g., school type, location) level characteristics. Multiple logistic regression analyses identified predictive models for being a perpetrator of sexual violence.

RESULTS

Fifty-two students reported perpetration of sexual violence in the past year, including 29 rapes. Overall, self-reported perpetrators of sexual violence are more likely to be men, to have been a victim in his or her lifetime, to have smoked marijuana in the past 12 months (but not the past month), and to be younger (18 or 19 years old). Institutional level characteristics, including school type and location, did not yield significant associations with perpetration.

DISCUSSION

Sexual violence prevention and response efforts toward college students need to be inclusive, especially targeting individual level factors, and considerate of the victimization-perpetration comorbidity experienced by many students.

Lesbian, gay and bisexual college student perspectives on disparities in weight-related behaviours and body image: a qualitative analysis

AIMS AND OBJECTIVES

To (1) explore college students' perceived sexual orientation-related barriers to engaging in physical activity, eating healthfully and maintaining healthy body images and (2) identify types of campus resources on physical activity, healthy eating and body image available to lesbian, gay and bisexual college students.

BACKGROUND

Previous research has highlighted sexual orientation disparities in weight status, physical activity, healthy eating and body image. Despite this, little is known about the context surrounding these disparities.

DESIGN

Cross-sectional study using individual interviews.

METHODS

Thirty (15 males, 15 females) lesbian, gay, bisexual, queer and pansexual-identified college students, aged 18-30 years participated in the study. Quasi-inductive coding was used to analyse transcribed interview data and an iterative coding process was used to organise data into themes.

RESULTS

Many felt their sexual orientation helped them be physically active, engage in healthful eating habits and have a positive body image. However, sexual orientation was also identified as a stressor that adversely impacted physical activity and eating habits.

CONCLUSIONS

Lesbian, gay and bisexual students may have to negotiate their sexuality in ways that could adversely influence their physical activity, eating habits and body image. Both clinical and institutional interventions should be inclusive of all people, including lesbian, gay and bisexual, queer, and pansexual students. Further, tailored interventions to meet the specific health needs of sexual minority populations are needed.

RELEVANCE TO CLINICAL PRACTICE

Clinicians need to understand the context in which sexual minority young adults experience health promotion messaging and programming. Clinic-based tailored interventions are critical as part of a multi-faceted approach in promoting physical activity and healthier eating habits for all young people, including lesbian, gay, bisexual, queer and pansexual, to more effectively address the prevention of chronic diseases.